糖尿病肾病患者自身抗体检测的意义
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摘要
目的探讨糖尿病肾病(DN)患者抗肾小球基底膜抗体(anti-GBM antibody)、抗心磷脂抗体(ACA)、尿酸(UA)和同型半胱氨酸(Hcy)检测的意义,为DN的诊断和治疗提供依据。方法收集174例2型糖尿病(T2DM)患者的血清,依据肾小球滤过率(GFR)和尿蛋白/肌酐比值(ACR)分为单纯糖尿病组(A组)、早期糖尿病肾病组(B组)、临床肾病组(C组)和肾功能不全组(D组)。采用间接酶联免疫法检测GBM和ACA,酶法检测UA和Hcy。结果进行统计学分析。结果 B组UA、Hcy和抗心磷脂抗体免疫球蛋白M(ACAIgM)水平高于A组,C组和D组UA、Hcy、GBM、抗心磷脂抗体免疫球蛋白G(ACA-Ig G)和抗心磷脂抗体免疫球蛋白A(ACA-IgA)水平高于A组,差异有统计学意义(P <0.05);C组UA和Hcy水平高于B组,D组UA、Hcy、GBM和ACA-IgA水平也高于B组,差异有统计学意义(P <0.05);D组UA、Hcy和GBM水平高于C组,差异有统计学意义(P <0.05)。GBM、ACA-IgA、UA和Hcy分别与ACR呈正相关(r=0.281、0.206、0.411和0.492,P <0.05),ACA-Ig G和ACA-IgM与ACR无相关性。结论血清UA、Hcy和ACA-IgM水平可提示早期肾损害,血清GBM、ACA、UA和Hcy可作为DN疾病进程的监测指标。
Objective To investigate the significance of anti-glomerular basement membrane(anti-GBM),anti-cardiolipin antibodies(ACA), uric acid(UA) and homocysteine(Hcy) in patients with diabetic nephropathy(DN), and provide a basis for the diagnosis and treatment of DN. Methods Totally 174 patients with type 2 diabetes mellitus(T2DM) were divided into four groups according to estimated Glomerular Filtration Rate(GFR) and anurinary albumin to creatinine ratio(ACR): diabetic mellitus group(A group), early diabetic nephropathy group(B group), clinic diabetic nephropathy group(C group) and renal insufficiency group(D group). GBM and ACA were detected by indirect enzyme-linked immunosorbent assay, and UA and Hcy were detected by enzymatic method.The results were statistically analyzed. Results Compared with A group, UA, Hcy and anti-cardiolipin antibodies immune globulin M(ACA-IgM) levels in B group were increased, and levels of UA, Hcy, GBM, anti-cardiolipin antibodies immune globulin G(ACA-IgG) and anti-cardiolipin antibodies immune globulin A(ACA-IgA) in C group and D group were higher than those in A group, the differences were statistically significant(P < 0.05). Compared with B group, levels of UA and Hcy in C group were increased, and levels of UA, Hcy, GBM and ACA-IgA in D group were also increased, the differences were statistically significant(P < 0.05). Compared with C group, UA,Hcy and GBM levels in D group were increased, the differences were statistically significant(P < 0.05). ACR was negatively correlated with GBM, ACA-IgA, UA and Hcy(r = 0.281, 0.206, 0.411 and 0.492, P < 0.05), but not correlated with ACA-IgG and ACA-IgM. Conclusions Serum levels of UA, Hcy and ACA-IgM may indicate early renal damage. Serum GBM, ACA, UA and Hcy may be used as monitoring indicators for DN disease progression.
Objective To investigate the significance of anti-glomerular basement membrane(anti-GBM),anti-cardiolipin antibodies(ACA), uric acid(UA) and homocysteine(Hcy) in patients with diabetic nephropathy(DN), and provide a basis for the diagnosis and treatment of DN. Methods Totally 174 patients with type 2 diabetes mellitus(T2DM) were divided into four groups according to estimated Glomerular Filtration Rate(GFR) and anurinary albumin to creatinine ratio(ACR): diabetic mellitus group(A group), early diabetic nephropathy group(B group), clinic diabetic nephropathy group(C group) and renal insufficiency group(D group). GBM and ACA were detected by indirect enzyme-linked immunosorbent assay, and UA and Hcy were detected by enzymatic method.The results were statistically analyzed. Results Compared with A group, UA, Hcy and anti-cardiolipin antibodies immune globulin M(ACA-IgM) levels in B group were increased, and levels of UA, Hcy, GBM, anti-cardiolipin antibodies immune globulin G(ACA-IgG) and anti-cardiolipin antibodies immune globulin A(ACA-IgA) in C group and D group were higher than those in A group, the differences were statistically significant(P < 0.05). Compared with B group, levels of UA and Hcy in C group were increased, and levels of UA, Hcy, GBM and ACA-IgA in D group were also increased, the differences were statistically significant(P < 0.05). Compared with C group, UA,Hcy and GBM levels in D group were increased, the differences were statistically significant(P < 0.05). ACR was negatively correlated with GBM, ACA-IgA, UA and Hcy(r = 0.281, 0.206, 0.411 and 0.492, P < 0.05), but not correlated with ACA-IgG and ACA-IgM. Conclusions Serum levels of UA, Hcy and ACA-IgM may indicate early renal damage. Serum GBM, ACA, UA and Hcy may be used as monitoring indicators for DN disease progression.
引文
[1]JANSSON S P,ANDERSSON D K,SVRDSUDD K.Mortality trends in subjects with and without diabetes during 33 years of follow-up[J].Diabetes Care,2010,33(3):551-556.
[2]王雅依,汪浩,李晓玲,等.炎性指标与免疫学指标在糖尿病患者肾脏病变诊断与预后判断中的价值[J].中国现代医学杂志,2016,26(12):49-52.
[3]赵令君,刘玉峰,吴淋淋,等.糖尿病肾病最新国际病理诊断标准的临床应用研究[J].中国实验诊断学,2014,35(5):847-848.
[4]杨力,檀增恒,李丽,等.芪明颗粒治疗糖尿病肾病的临床研究[J].海南医学,2014,25(13):1896-1898.
[5]柴凌雄,罗群,周芳芳,等.Hcy、hsCRP、Lpa、尿NAG对糖尿病肾病早期诊断的临床意义[J].中国现代医生,2012,50(34):42-44.
[6]虞有超,俞海瑾,侯小霞,等.原发性抗中性粒细胞胞浆抗体相关性血管炎的临床表现及肺部CT特征[J].中华全科医师杂志,2016,15(7):534-538.
[7]霍江萍,丁守生,王福民,等.抗心磷脂抗体检测肾病综合征患儿高凝倾向的临床意义[J].潍坊医学院学报,2000,22(4):287-289.
[8]World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complication.Report of a WHOconsultation.Part 1:Diagnosis and classification of diabetes mellitus[R].Geneva,World Health Organization,1999.
[9]李青,潘洁敏,包玉倩,等.2型糖尿病肾脏疾病患者血尿酸水平与肾功能不全的相关性[J].上海医学,2013,36(1):59-62.
[10]何建秋,王艳新.2型糖尿病肾病患者血尿酸与肾素-血管紧张素-醛固酮系统的相关性研究[J].重庆医学,2017,46(35):5014-5015.
[11]秦胜花.2型糖尿病肾病患者糖化血红蛋白与尿酸检测的意义[J].中国医药指南,2010,8(20):35-36.
[12]EUN H C,EUN H K,WON GU KIM,et al.Homocysteine as a risk factor for development of microalbuminuria in type 2diabetes[J].Korean Diabetes J,2010,34(3):200-206.
[13]KAESAB A,AJMI T,ISSAOUI M,et al.Homocysteine enhances LDL fatty acid peroxidation,promoting microalbuminuria in type2 diabetes[J].Clin Bioehem,2008,45(5):476-480.
[14]朱厚玲,邱红渝.抗基底膜抗体肾炎伴抗中性粒细胞胞浆抗体阳性的新月体肾小球肾炎一例[J].华西医学,2017,32(5):795-796.
[15]范莲芝,孙喜明,王桂英,等.高糖对血管内皮细胞增殖及HGFm-RNA表达作用的影响[J].中西医结合心脑血管病杂志,2010,8(9)::1109-1111.
[2]王雅依,汪浩,李晓玲,等.炎性指标与免疫学指标在糖尿病患者肾脏病变诊断与预后判断中的价值[J].中国现代医学杂志,2016,26(12):49-52.
[3]赵令君,刘玉峰,吴淋淋,等.糖尿病肾病最新国际病理诊断标准的临床应用研究[J].中国实验诊断学,2014,35(5):847-848.
[4]杨力,檀增恒,李丽,等.芪明颗粒治疗糖尿病肾病的临床研究[J].海南医学,2014,25(13):1896-1898.
[5]柴凌雄,罗群,周芳芳,等.Hcy、hsCRP、Lpa、尿NAG对糖尿病肾病早期诊断的临床意义[J].中国现代医生,2012,50(34):42-44.
[6]虞有超,俞海瑾,侯小霞,等.原发性抗中性粒细胞胞浆抗体相关性血管炎的临床表现及肺部CT特征[J].中华全科医师杂志,2016,15(7):534-538.
[7]霍江萍,丁守生,王福民,等.抗心磷脂抗体检测肾病综合征患儿高凝倾向的临床意义[J].潍坊医学院学报,2000,22(4):287-289.
[8]World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complication.Report of a WHOconsultation.Part 1:Diagnosis and classification of diabetes mellitus[R].Geneva,World Health Organization,1999.
[9]李青,潘洁敏,包玉倩,等.2型糖尿病肾脏疾病患者血尿酸水平与肾功能不全的相关性[J].上海医学,2013,36(1):59-62.
[10]何建秋,王艳新.2型糖尿病肾病患者血尿酸与肾素-血管紧张素-醛固酮系统的相关性研究[J].重庆医学,2017,46(35):5014-5015.
[11]秦胜花.2型糖尿病肾病患者糖化血红蛋白与尿酸检测的意义[J].中国医药指南,2010,8(20):35-36.
[12]EUN H C,EUN H K,WON GU KIM,et al.Homocysteine as a risk factor for development of microalbuminuria in type 2diabetes[J].Korean Diabetes J,2010,34(3):200-206.
[13]KAESAB A,AJMI T,ISSAOUI M,et al.Homocysteine enhances LDL fatty acid peroxidation,promoting microalbuminuria in type2 diabetes[J].Clin Bioehem,2008,45(5):476-480.
[14]朱厚玲,邱红渝.抗基底膜抗体肾炎伴抗中性粒细胞胞浆抗体阳性的新月体肾小球肾炎一例[J].华西医学,2017,32(5):795-796.
[15]范莲芝,孙喜明,王桂英,等.高糖对血管内皮细胞增殖及HGFm-RNA表达作用的影响[J].中西医结合心脑血管病杂志,2010,8(9)::1109-1111.